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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � ,
Date: Permit Number: b "`r 3 z_
L(' 5 12 I R ReCEIVED
Building Permit Application - APR 27201
8
Planning and Development Services Permlttn
Building and Code Regulation Division St• Lu9e ePartm nt
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: . cCleapac J j
Address: 5-,01. "PQ 1 yn t-\ 0 t e i-L�k Q� Ca L '34 Ct a
Legal Description: /nd,etvi n 14 ' /.?I/S ( L„ta4`3 e/5 y6.
Property Tax ID#: 3 C102 ` 'C) 7- d O l 7- .000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit-check all apply:
HVAC [1 Gas Tank nGas Piping 1 Shutters Endows/Doors
ElElectric 0 Plumbing Sprinklers El Generator I-1 Roof Roof pitch
Total Sq. Ft of Construction: Sc, Ft•of First Floor:
Cost of Construction:$ / 269O Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE:. CONTRACTOR:
Name �� c-e_/,et 630 4- Name: GI jher•(-o Rio S
Company: lPI G G.c r., e /_L C—
City: b--L Q ' Cci2 t State: -(.- Address: '7/ .5u.) 6.e d o A/vcQ.
Zip Code: 3 cm 8'a Fax: City: Poc# S3. Lc.) c.% State: -t-
Phone No. 7 7 Z.- €14, q- 010 3 Zip Code: 3 l R fS3 Fax:
E-Mail: AJ* Phone No. 77Z- 0Z07 - 53 6, 8'
Fill in fee simple Title Holder on next page(if different E-Mail: r9.3‘-ca-,s 6-‘('L k120° Cvrit
from the Owner listed above) State or County License: 3 D 3 7'5
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name: i`
Address: z Address: 7'
City: `
' State: City: Z State:
Zip: Phone / Zip: Phone:
7
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY,: _Not Applicable
Name: Name:
Address: / Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin: work or recordin: our Notice of Commencement.
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._imp, _,,,Aii ' Aj; ' /Aff '
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Signature of Owner /Contractor as Agent for Owner Signature of Contractor/ ',dense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST ., Loci a COUNTY OF 51. Lo C i e
The forgoing instrument was acknowledge efore me ThefprgQing instrument wa acknowledged efore me
thiso� 7 day of . ( 2015 by this_oL 1day of ,20 \6by
lis C , k,-,-,,,,,-1--c) ;,
Name o erson making statement Name ojgn making statement
Personally Know? OR Produced Identification Personally Known— OR Produced Identification
Type of Identification Type of Identification
P .duc ' educed
\ 411111111.1 111111101111_ gib glitt-Vaik
(Sign.ture of Notary'-St. t5r:r11 (Sig ature of Notary Public-
MORAIMA RAMOS tµr,. MORAIMA RAMOS
Commis ••• No. =o,........,g6 o: a�
( MMISSION#GG156738 Commi Sion No. ?F o M'��b1lISSION#GG156738
c.\ CC . ',i EXPIRES:OCT 31,2021 i ; EXPIRES:OCT 31,2021
cm
`J�� n`OFP Bonded through 1st State Insurance (���
, Bonded through 1st State Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17